Emergency care assessment, psychological considerations

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Emergency care
Emergency care can be defined as the episodic and crisis-oriented care provided to patients with serious or potentially life-threatening injuries or illnesses
EMERGENCY ASSESSMENT
Initial Assessment: Form a general impression of the patient
Assess the Patient's Mental Status:
Classify the patient's mental status into one of the following categories:
·        Alert
·        Verbal
·        Painful
·        Unresponsive
The primary survey: Mnemonic ABCD
Airway
·        Does the patient have an open airway?
·        Is the patient able to speak?
·        Check for airway obstructions such as loose teeth, foreign objects, bleeding, vomits or other secretions.
·        Treat immediately

Breathing
·        Is the patient breathing?
·        Assess for equal rise and fall of the chest
·        Respiratory rate and pattern     
·        Skin color
·        Use of accessory muscles
·        Integrity of the chest wall
·        position of the trachea.
Circulation:
·        Palpate a central pulse?
·        What is the quality (strong, weak, slow, rapid)?
·        Is the skin warm and dry?  
·        Is the skin color normal?
·        Obtain a blood pressure
Disability:
·        Assess level of consciousness and pupils
·        Assess level of  by GCS scale:
·        Is the patient alert?
·        Does the patient respond to voice?
·        Does the patient respond to painful stimulus?
·        The patient is unresponsive even to painful stimulus.
Secondary Assessment: Mnemonic:"EFG"
Expose
Head, neck, Chest, Abdomen
Examine for any injuries
Environmental control: prevent heat loss by using warm blankets, overhead warmers, and warmed I.V. fluids


Full set of vital signs
·        Obtain a full set of vital signs
·        obtain blood pressure in both arms if chest trauma is suspected.
Five interventions
·        cardiac monitoring 
·        pulse oximetry to measure the oxygen saturation
·        Indwelling urinary catheter
·        gastric tube
·        Laboratory studies
Ø Blood group and cross matching
Ø hemoglobin and hematocrit
Ø urine drug screen
Ø blood alcohol,
Ø electrolytes
Ø prothrombin time (PT) and partial thromboplastin time
Ø pregnancy test if applicable
Facilitate family presence
If any member of the family wishes to be present-during-the-resuscitatjon, it is imperative to assign a staff member to that person to explain what is being done and offer support
Give comfort measures: verbal reassurances as well as pain management.
          Focused History & Physical Exam - Trauma
·        Re-evaluate Mechanism of Injury (MOI) 
·        Significant MOI? Yes/No
o   Is patient unresponsive or disoriented?        
·        Is patient under the influence of drugs or alcohol?
·        Patients with Significant MOI
RAPID TRAUMA ASSESSMENT
DCAP-BTLS
·        D - Deformities
·        C - Contusions
·        A - Abrasions
·        P - Punctures/Penetrations
·        B - Burns
·        T - Tenderness
·        L - Lacerations
·        S -Swelling
Quickly Obtain Baseline Vital Signs
S-A-M-P-L-E History
S - Signs & Symptoms
A – Allergies: Medications, Foods, Environment
M - Medications
·        Are you taking any?
·        When did you last take your medication?
·        What are they?
·        What are they for?
·        May I see them?
P - Previous Medical History
·        Pertinent
·        Related to this complaint
·        Complicating factor
L - Last Oral Intake Food and/or Drink?
·        What?
·        When?
E - Events leading up to the incident
·        What happened?
·        When?
Physical assessment
Head-to-Toe Assessment patient's general appearance, including body position or any guarding or posturing.
Head and face
·        Inspect for any lacerations, abrasions, contusions, puncture wounds, ecchymosis, edema Palpate for crepitus, crackling, or bony deformities.

Chest:
·        Inspect for breathing effectiveness, paradoxical chest wall movement, disruptions in chest wall integrity.
·        Auscultate for bilateral breath sounds and heart sounds
·        Palpate for bony crepitus or deformities
Abdomen/flanks
·        Inspect for lacerations, abrasions, contusions, puncture wounds, ecchymosis, edema, scars or distention.
·        Auscultate for the presence of bowel sounds.
·        Palpate for rigidity, guarding, masses, or areas of tenderness Pelvis/perineum
·        Inspect for lacerations, abrasions, contusions, puncture wounds, ecchymosis, edema, or scars
·        Look for blood at the urinary meatus.
·        Palpate for pelvic instability and anal sphincter tone
Extremities
·        Inspect skin colour and temperature.
·        Look for signs of injury and bleeding.
·        Does the patient have movement and sensation of all extremities?
·        Palpate peripheral pulses
·        Bony crepitus Areas of tenderness
·        Posterior surfaces
·        Inspect for possible injuries-
·        Palpate the vertebral column and all tenderness
Focused Assessment
Any injuries that were identified during the primary and secondary sunseys require a detailed assessment.
PSYCHOLOGICAL CONSIDERATIONS
Approach to the Patient
·        Understand and accept the basic anxieties of the acutely traumatized patient.
·        Understand and support the patient's feelings concerning loss of control.
·        Treat the unconscious patient as if conscious.
·        Avoid making negative comments about the patient's condition. Be prepared to handle all aspects of acute trauma know what to expect and what to do.
Approach to the Family
·        Inform about patient admission unit
·        Give as much information about the treatment.
·        Allowing a family member to be present during the resuscitation.
·        Recognize the anxiety of the family
·        Acknowledge expressions of anger, guilt, and criticism. Deal with reality as gently and quickly as possible Avoid encouraging and supporting denial.




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notes.nursium.com: Emergency care assessment, psychological considerations
Emergency care assessment, psychological considerations
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